Neighbourhood socioeconomic inequalities in incidence of acute myocardial infarction: a cohort study quantifying age- and gender-specific differences in relative and absolute terms

Carla Koopman, Aloysia A M van Oeffelen, Michiel L Bots, Peter M Engelfriet, W M Monique Verschuren, Lenie van Rossem, Ineke van Dis, Simon Capewell, Ilonca Vaartjes, Carla Koopman, Aloysia A M van Oeffelen, Michiel L Bots, Peter M Engelfriet, W M Monique Verschuren, Lenie van Rossem, Ineke van Dis, Simon Capewell, Ilonca Vaartjes

Abstract

Background: Socioeconomic status has a profound effect on the risk of having a first acute myocardial infarction (AMI). Information on socioeconomic inequalities in AMI incidence across age-gender-groups is lacking. Our objective was to examine socioeconomic inequalities in the incidence of AMI considering both relative and absolute measures of risk differences, with a particular focus on age and gender.

Methods: We identified all patients with a first AMI from 1997 to 2007 through linked hospital discharge and death records covering the Dutch population. Relative risks (RR) of AMI incidence were estimated by mean equivalent household income at neighbourhood-level for strata of age and gender using Poisson regression models. Socioeconomic inequalities were also shown within the stratified age-gender groups by calculating the total number of events attributable to socioeconomic disadvantage.

Results: Between 1997 and 2007, 317,564 people had a first AMI. When comparing the most deprived socioeconomic quintile with the most affluent quintile, the overall RR for AMI was 1.34 (95 % confidence interval (CI): 1.32-1.36) in men and 1.44 (95 % CI: 1.42-1.47) in women. The socioeconomic gradient decreased with age. Relative socioeconomic inequalities were most apparent in men under 35 years and in women under 65 years. The largest number of events attributable to socioeconomic inequalities was found in men aged 45-74 years and in women aged 65-84 years. The total proportion of AMIs that was attributable to socioeconomic inequalities in the Dutch population of 1997 to 2007 was 14 % in men and 18 % in women.

Conclusions: Neighbourhood socioeconomic inequalities were observed in AMI incidence in the Netherlands, but the magnitude across age-gender groups depended on whether inequality was expressed in relative or absolute terms. Relative socioeconomic inequalities were high in young persons and women, where the absolute burden of AMI was low. Absolute socioeconomic inequalities in AMI were highest in the age-gender groups of middle-aged men and elderly women, where the number of cases was largest.

Figures

Figure 1
Figure 1
Distribution of Dutch population from 1997 to 2007 by age, gender and socioeconomic quintile. A total of 176,715,060 person-years is expressed in millions of person-years. Socioeconomic quintiles are ranked at the neighbourhood level according to their mean equivalent household income, quintile 1 is least deprived. Distribution of population aged <30 year is not displayed. Men (left), women (right).
Figure 2
Figure 2
Socioeconomic inequalities in AMI incidence across age-gender groups in relative and absolute terms. Relative risks (RRs) for acute myocardial infarction (AMI) per age-gender group by socioeconomic quintile (lines) and distribution of excess number of AMI events attributable to socioeconomic inequalities (shaded bars) in the Netherlands between 1997 and 2007. RRs are obtained from Poisson regression and compare incidence rates with socioeconomic quintile 1 as reference category. Total excess events are the total number of AMI events in the age-gender groups in the population that would have been eliminated if all had the same risk for AMI as those in socioeconomic quintile Q1.

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